Catheter insertion

1. URINARY BLADDER
CATHETERISATION
Cristi Francis
CRRI

2. Catheterization of the urinary bladder is the
insertion of a hollow tube through the
urethra into the bladder for removing urine.

3. INDICATIONS
 Relieve Urinary Retention.
 Obtain a Sterile Urine Specimen from a
Female Patient.
 Measure Residual Urine.
 Empty the Bladder Before, During, or After
Surgery.
 Allows accurate measurement of urine
output.

4. CONTRAINDICATIONS
 Traumatic injury to the lower urinary tract
is a contraindication for urethral
catheterization in women.
 HOWEVER ,Suspected bladder injury is not
a contraindication to placement of a
urethral catheter

5. SIZES
Number 8Fr. and 10 Fr.
are used for children.
Number 14 Fr. and 16 Fr.
are used for female
adults.
Number 20 Fr. and 22 Fr.
are usually used for male
adults.

6. TYPES
Intermittent Catheter. An
intermittent catheter is
used to drain the
bladder for short
periods (5-10 minutes). It
may be inserted by the
patient.

7.  Retention/Indwelling
Catheter. This type of
catheter is placed into
the bladder and
secured there for a
period of time.
 Eg: Foley’s Catheter.

8.  Supra Pubic Catheter. This
type of catheter is
inserted into the bladder
through a small incision
above the pubic area. It
is used for continuous
drainage.

9. PROCEDURE
 Gather all equipment
 Explain the Procedure to the Patient.
 Provide for Privacy and Adequate
Lighting.
Positioning
 Male - Supine Position
 Female - Dorsal recumbent Position

10. INSERTION OF FOLEY’S CATHETER
 Cleanse the genital and
perineal areas with warm soap
and water. Rinse and dry.
 Wash hands and put on sterile
glove.
 Catheterization is an aseptic
procedure for which sterile
equipment is required. Open
the sterile drape and place on
the patient's thighs
 Apply sterile lubricant liberally to
the catheter tip. Lubricate at
least six inches of the catheter.
Leave the lubricated catheter
on the sterile field.

11. Male
Retract the foreskin using the thumb
and fore finger of non dominant hand
(the gloved hand that has touched
the patient is now unsterile and should
not be used to hold the catheter)
Using the forceps hold and cotton
covered on antiseptic solution
swab the center of the meatus in a
circular manner,continue outward
progressively larger circle. Clean the
entire glans.

12.  Hold the shaft at a 90-
degree angle. Advance the
catheter into the urinary
meatus till you encounter
resistance at the prostatic
sphincter.
 Pause and allow the
sphincter to relax.
 Lower the shaft and
continue to advance the
catheter.
 Never force the catheter to
advance. Discontinue the
procedure if the catheter
will not advance or the
patient has unusual
discomfort.

13.  When the catheter has
passed through the
prostatic sphincter
urine will start to flow.
Inflate balloon, using correct
amount of sterile liquid
(usually 10 cc but check
actual balloon size)
Gently pull catheter until
inflation balloon is snug
against bladder neck
Connect catheter to
Urobag

14.  Place the
drainage bag
below the level
of the bladder
 Remove gloves,
dispose of
equipment
appropriately,
wash hands
 Document size of
catheter
inserted, amount
of water in
balloon

15. Female
 Place the thumb and
forefinger of your
nondominant hand between
the labia minora, spread and
separate upward. The gloved
hand that has touched the
patient is now contaminated.
 Using the forceps, pick up a
cotton ball saturated with
antiseptic solution
 Swab from above the meatus
downward toward the
rectum.
 Clean each side of the
meatus.

16.  Insert the lubricated
catheter into the
female patient's
urinary meatus
 Angle the catheter
upward as it is
advanced.
 Do not force the
catheter.

17.  Inflate balloon, using
correct amount of
sterile liquid (usually 10
cc but check actual
balloon size)
 Gently pull catheter
until inflation balloon is
snug against bladder
neck Remove gloves,
dispose of equipment
appropriately, wash
hands
 Document size of
catheter inserted,
amount of water in
balloonConnect
catheter to the
Urobag.
Secure the catheter to the inner
aspect of the female patient's thigh
Place drainage bag below level of
bladder

18. COMPLICATIONS
 INFECTIONS including urethritis, cystitis,
pyelonephritis, and transient bacteremia
 Paraphimosis, caused by failure to reduce
the foreskin after catheterization
 Urethral strictures
 Urethral perforation
 Bleeding

19.  Noninfectious complications
of short- and long-term
catheterization include
accidental removal, catheter
blockage, gross hematuria,
and urine leakage, and these
are at least as common as
clinically significant urinary
tract infections in this patient
population.

20.  A larger than standard catheter should be
used when the indication for placement is
continuous bladder irrigation for hematuria
and clots. A 3-way catheter (with an
additional port) is often used in conjunction
with a large-volume reservoir to create a
“Murphy drip” for continuous irrigation.
 Prophylactic antibiotics are recommended
for patients with a prosthetic heart valve or
an artificial urethral sphincter.

21.  The timing of long-term indwelling urinary
catheter changes should be
individualized. Indications for changing
the catheter include obstruction (eg, by
encrustation or mucus), symptomatic
infection, or leakage around the
catheter.

22. Thank You for your
patient listening